Standard imaging-guided chest wall perforator flap reconstruction without intraoperative handheld Doppler for granulomatous lobular mastitis: a simplified approach for resource-limited settings.

Background: Surgical management of granulomatous lobular mastitis (GLM) requires balancing complete lesion excision with the preservation of breast aesthetics. While the chest wall perforator flap (CWPF) is a valuable volume replacement technique, its clinical adoption may be limited by the need for intraoperative handheld Doppler localization and specialized training. This study aimed to evaluate the efficacy of a simplified CWPF reconstruction approach guided by multimodal preoperative imaging and performed without intraoperative handheld Doppler. Methods: A retrospective analysis was performed on 80 patients diagnosed with GLM between January 2022 and May 2024. Patients were assigned to two groups: Group A (n=43) underwent extended mass resection followed by modified CWPF reconstruction without intraoperative handheld Doppler, while Group B (n=37) received conventional surgical therapy (simple lumpectomy, extended mass resection, or segmental mastectomy without reconstruction). Group A was managed via a multimodal imaging protocol: magnetic resonance imaging (MRI) for source vessel identification, computed tomography (CT) for skeletal landmark referencing, and ultrasound for surface marking, thereby eliminating the need for intraoperative handheld Doppler localization. Results: All CWPF flaps were harvested under preoperative imaging guidance without the use of a handheld Doppler device. Postoperative complication rate was comparable between groups, mainly involving delayed wound healing, positive bacterial culture, subcutaneous fat liquefaction, incision infection, nipple-areola ischemic necrosis, ecchymosis, or hematoma (all P>0.05). Notably, Group A achieved significantly superior cosmetic outcomes compared with Group B (P<0.001). Patients in Group A also reported improved quality of life and higher patient satisfaction (P<0.001). Conclusions: Precise preoperative planning using multimodal imaging (MRI, CT, ultrasound) enables safe and effective CWPF reconstruction without intraoperative handheld Doppler in GLM surgery. This streamlined approach maintains surgical precision and favorable aesthetic outcomes while potentially reducing dependence on additional intraoperative localization devices, and may represent a practical strategy for breast reconstruction in resource-limited settings.